Ear Reconstructive Surgery

To create a new ear as a result of birth defects such as microtia , trauma or previous surgery, the choices are either to use tissue from the patients own body (autogenous reconstruction) or to use synthetic materials (alloplastic reconstruction).

Autogenous reconstruction involves making a new ear from the patients rib cartilage which is then placed under the skin on the side of the scalp where the ear should have been. This surgery is performed in 2 stages. This technique of using rib cartilage is by far the most reliable and commonly used technique amongst the world’s leading ear reconstructive surgeons.

Dr Nicholas Lotz frequently performs ear reconstructive surgery for microtia in Sydney, Australia.

First Stage:

The first stage operation is usually performed after the age of 10 years. Your child will usually be admitted to hospital on the day of the surgery. The procedure is performed under a general anaesthetic. A tracing will be made of the normal ear if there is one, which will be used to design the framework for the reconstruction. Cartilage is harvested from the chest wall, through an incision which is around 10cm long.

The cartilage from 3 ribs is removed and carved into a framework which is designed to resemble the other ear. 2 drains will be placed in the ear to suck the skin into all the crevices of the ear. These will remain in place for around 5 days. The stitches will be removed after around 1 week.

Examples of ear frameworks sculpted from rib cartilage by Dr Lotz.

At the completion of stage 1, the ear will have all the normal shapes when seen from the side, but it will be flat against the side of the head.

Second Stage: 

The second stage of the ear reconstruction, which involves elevation of the newly created ear from the side of the head, is performed at least six months after the first operation. During this surgery, most of the side of the head will need to be shaved. An incision is made around the back of the new ear, and the ear is lifted up from the side of the head. Some cartilage from the first operation, which has been stored in the chest scar, is placed under the ear to help to hold it out from the head. The new groove behind the ear is covered with some tissue from under the scalp and then covered with a skin graft to line the new groove with skin. A drain is placed in the scalp, and dressings are put on. The hospital stay after the second operation is usually shorter (often only overnight), and the pain is much less.

An alternative to autogenous reconstruction with cartilage graft is a plastic clip-on ear (prosthesis), which attaches to surgically placed studs in the bone on the side of the head. This technique is occasionally useful if for some reason it is not possible to create an ear using rib graft.

Sometimes your child may require surgery to pin back the normal ear to more closely match the projection of the reconstructed one.

PHOTO GALLERY

Case 1: 13 year-old boy with isolated right microtia. Reconstruction performed in 2 stages using rib grafts.

Pre Operative

Post Operative - completion of reconstruction

(Click on image thumbnails above to view larger images)

• If you would like further information about Ear Reconstruction or Surgical Treatments for Microtia and or wish to make an appointment to discuss a surgical procedure with Dr Lotz please Contact Dr Nicholas Lotz.